We have long treated the dictum to restrict sodium intake in heart failure as a pillar of best practices and a sacrosanct edict that populates the core database for all physicians treating cardiovascular disease. Guidelines have mandated empirical thresholds that are to be respected, and consensus statements from leading organizations further make the case for sodium restriction as a basic tenet of good cardiovascular care.1 However, like many other dogmatic statements that were fully embedded in cardiovascular medicine—for example, suppression of premature ventricular contractions, avoidance of β-blockers in left ventricular dysfunction, and use of hormone replacement therapy in women at risk for cardiovascular disease—the time has now come for sodium restriction in heart failure to be critically reevaluated. There is simply too much uncertainty for a conviction we hold as truth. At a minimum, rigorous testing in well-performed randomized clinical trials is needed. There should be only 1 goal: valid evidence leading to a much more informed position, actionable guidelines, and personalized implementation.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Yancy CW. Sodium Restriction in Heart Failure: Too Much Uncertainty—Do the Trials. JAMA Intern Med. 2018;178(12):1700–1701. doi:10.1001/jamainternmed.2018.4653
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: